Various Medicare and Medicaid auditing initiatives have sharply lowered erroneous excess payments under the programs over the past three years, according to the Obama administration, and new initiatives will lower such mistaken spending further.
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HMS Holdings Corp., a New York-based benefits coordinator for payers, has signed a definitive agreement to acquire privately held HealthDataInsights, Las Vegas, a recovery audit contractor technology firm, for approximately $400 million.
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Audits that have turned up more than $680 million so far in Medicare payment errors started slowly in the first year, a new report shows. More recent data suggest auditors have grown more aggressive as the program prepares to expand. The first report to Congress on Medicare's Recovery Audit Contractor Program, released in late September covering the federal fiscal year beginning Oct. 1, 2009, provides an overview of auditors' first year as federal officials move to broaden audits under Medicare and expand them to Medicaid, and as Congress seeks ways to further curb federal spending.
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My question is, how much of the recovery included simple coding mistakes—i.e. duplicate lines etc.—that the financial intermediary could have and should have caught?
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Hospitals fear Medicaid's new audit program could mean multiple examinations of the same issues from different reviewers, as well as more reviews of the medical necessity of hospital care.The final rule establishing a Medicaid recovery audit contractor program addressed some concerns raised by hospitals over an earlier draft, but not all of them.
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Building on the Medicare Recovery Audit Contractor program, HHS on Wednesday issued a final rule to establish a Medicaid Recovery Audit Contractor program that the agency expects will save $2.1 billion in waste over the next five years.
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The CMS' Medicare fee-for-service recovery audit contractor program collected about $233.4 million in overpayments from March through June of this year, bringing the total of recouped overpayments since October 2009 to about $575.2 million.
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The nation's healthcare system is said to be facing a physician shortage just as 30 million uninsured individuals are about to enter the patient pool and threaten to overload an already stressed system. The answer, say some, is better and wider use of nurse practitioners and physician assistants.
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The American Hospital Association said last week that it is pleased the CMS has released data on what it has recouped in improper Medicare payments, but would still like to see information about the appeals process in the agency's recovery audit contractor program.
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The CMS has collected more than $313 million in Medicare overpayments through its recovery audit program since October 2009, according to the CMS' most recent recovery-audit report—and nearly half of that was collected from January through March of this year.
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